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Ates O, Gocmen G, Kiv MC. Closed Reduction of an Isolated Zygomatic Arch Fracture Under Local Anesthesia: A Case Report. Cureus 2024; 16:e60987. [PMID: 38910678 PMCID: PMC11193938 DOI: 10.7759/cureus.60987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
The zygomatic bone is one of the most prominent bones in the facial region. It forms the most anterolateral projection on each side of the middle face and is articulated with the maxilla, frontal, and temporal bones. Isolated zygomatic arch fractures can occur when a direct force is applied to the zygoma. A variety of intraoral and extraoral techniques have been used as closed reduction techniques for isolated fractures of the zygomatic arch. In this case report, we aim to present our approach for the treatment of a 40-year-old patient with an isolated right zygomatic arch fracture. We used the Keen technique for the closed reduction of the fracture under local anesthesia due to its practicality and effectiveness.
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Affiliation(s)
- Ozan Ates
- Oral and Maxillofacial Surgery, Marmara University, Istanbul, TUR
| | - Gokhan Gocmen
- Oral and Maxillofacial Surgery, Marmara University, Istanbul, TUR
| | - Metin C Kiv
- Oral and Maxillofacial Surgery, Marmara University, Istanbul, TUR
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Soltani H, Allison SG, Chwa ES, Qureshi U, Aronson S, Yamada A. Revisiting the U-Shaped Elevator for Zygomaticomaxillary Fracture: Study and Comparison of Elevators for Zygomaticomaxillary Fracture Reduction. J Craniofac Surg 2023; 35:00001665-990000000-01259. [PMID: 38078912 DOI: 10.1097/scs.0000000000009880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/10/2023] [Indexed: 05/18/2024] Open
Abstract
The authors present the case of a 15-year-old male who sustained a unilateral zygomaticomaxillary complex fracture and underwent open reduction and rigid internal fixation, for which a U-shaped elevator was utilized. The authors discuss techniques in reduction and fixation of zygomaticomaxillary complex fractures, focusing on the use of various elevators during reduction, including straight-type and curved elevators. The U-shaped elevator is a handheld tool with bilateral symmetrically curved ends that is seldom used, despite its specific benefits including nonslip serrated tips, symmetrical nature that allows for direct loading needed for accurate reduction, visualization of the fracture site, and avoidance of tissue compression during elevation.
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Affiliation(s)
| | | | - Emily S Chwa
- Northwestern University Feinberg School of Medicine
| | - Umer Qureshi
- Division of Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital
| | - Sofia Aronson
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Akira Yamada
- Northwestern University Feinberg School of Medicine
- Division of Plastic and Reconstructive Surgery, Ann & Robert H. Lurie Children's Hospital
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Design and Use of a Pair of Computer-Designed Surgical Templates in Reduction of a Comminuted Zygomatic Arch Fracture. J Craniofac Surg 2022; 33:2606-2608. [DOI: 10.1097/scs.0000000000008664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
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Karm F, Selim J, Caruhel JB, Baus A, Trost O. Outpatient management of facial fractures in France: Current state. ANN CHIR PLAST ESTH 2022; 68:106-112. [PMID: 36328868 DOI: 10.1016/j.anplas.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 11/01/2022]
Abstract
Maxillofacial trauma is still very common in France with possible involvement of all face bones. Outpatient surgery is an axis strongly put forward by the public authorities. The aim of this study is to establish a current state in the outpatient management of facial fractures in France in 2019 before COVID infection. A closed and semi-open-ended questionnaire was sent to French hospitals treating facial fractures in order to evaluate current and possible future practices in terms of outpatient and perioperative management. Data extracted from the Program for giving Medical significance to Information Systems (PMSI) thanks to the Agency for Information on Hospital Care (ATIH) were also studied to obtain proportions of outpatient care by department. About the questionnaire 43 replies were received. Nasal fractures were the only type of fracture having a minimum average length of stay below 24hours (12.00±16.65) as well as an actual average length of stay (14.22±24.24). Concerning data extracted from the PMSI, 14510 stays were found. Currently only nasal fractures and zygomatic arch fractures requiring simple reduction without osteosynthesis are performed on an outpatient basis. Mandibular fractures could be performed as an outpatient procedure. Access to the operating room and organizational problems specific to each center are factors that limit the development of outpatient management of these facial fractures. Some incompressible parameters such as the monitoring required following the management of these fractures as well as the patients' comorbidities must be taken into account.
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Ritschl LM, Wittmann M, von Bomhard A, Koerdt S, Unterhuber T, Kehl V, Deppe H, Wolff KD, Mücke T, Fichter AM. Results of a Clinical Scoring System Regarding Symptoms and Surgical Treatment of Isolated Unilateral Zygomatico-Orbital Fractures: A Single-Centre Retrospective Analysis of 461 Cases. J Clin Med 2022; 11:jcm11082187. [PMID: 35456282 PMCID: PMC9032597 DOI: 10.3390/jcm11082187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Systematic assessment of computed tomography (CT) scans and clinical symptoms is necessary to quickly indicate the correct treatment of zygomatico-orbital (ZMO) fractures. For this purpose, a clinical scoring system (=Clinical Score) was developed and correlated with CT scans to analyse its validity. Every operated, isolated, and unilateral ZMO fracture between January 2012 and December 2016 was screened retrospectively, including patient and treatment data. All available CT scans were analysed, and the grade of dislocation was measured for each case and plane. Four hundred and sixty-one cases were included and showed a median surgery time of 66.0 min (5.0−361.0) and a median postoperative hospital stay of three days (0−25). The distribution of gender, aetiologies and age groups was significantly different (each p = 0.001), and the aetiology had a significant influence on the Clinical Score (p = 0.038). The degree of dislocation in the coronary and sagittal planes correlated significantly with the Clinical Score with regard to the orbital involvement (p < 0.001, ρ = 0.566; p < 0.001, ρ = 0.609). The simple, quick, and easy-to-apply Clinical Score showed a significant correlation with the most important planes in CT scans as well as with the clinical course. It may facilitate fast risk stratification of the patient. However, the validity of the proposed score in determining indications must now be evaluated in a prospective setting, including both operated and non-operated fractures.
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Affiliation(s)
- Lucas M. Ritschl
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
- Correspondence: ; Tel.: +49-89-4140-2932
| | - Matthias Wittmann
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Achim von Bomhard
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
| | - Tobias Unterhuber
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Victoria Kehl
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Grillparzerstrasse 18, 81675 Munich, Germany;
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
| | - Thomas Mücke
- Department of Oral and Maxillofacial Surgery, St. Josefs Hospital, 47441 Moers, Germany;
| | - Andreas M. Fichter
- Department of Oral and Maxillofacial Surgery, School of Medicine, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Straße 22, 81675 Munich, Germany; (M.W.); (A.v.B.); (T.U.); (H.D.); (K.-D.W.); (A.M.F.)
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Biomechanical Impact of a Zygoma Complex Fracture Using Human Cadaver. J Craniofac Surg 2021; 32:2045-2049. [PMID: 33770037 DOI: 10.1097/scs.0000000000007630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Zygomaticomaxillary complex fractures are common in midface trauma, with treatment often involving repair using titanium mini plates. However, the need for plate fixation along the zygomaticomaxillary suture on the infraorbital rim remains controversial. This study utilized a previously reported bite force simulator to investigate craniofacial strain patterns following zygomaticomaxillary complex fracture repairs with and without plating of the infraorbital rim. Osteotomies were made to 6 fresh-frozen cadaveric heads to simulate 2 types of zygomatic complex fractures: a dipod fracture with osteotomies at the zygomaticofrontal and zygomaticomaxillary sutures, and a tripod fracture with an additional osteotomies at the zygomaticotemporal suture. Repairs with and without the use of a titanium mini plate across the infraorbital rim were compared in both dipod and tripod fractures. Physiologically proportional masticatory loads were applied using the bite force simulator by actuating intrinsic muscle lines of action. The outcome metric was facial bone strains measured using uniaxial strain gauges. Mixed-effects linear models did not find a significant main effect on the overall strain pattern with the use of an infraorbital rim plate in both dipod (P = 0.198) and tripod (P = 0.117) fracture repairs. However, statistically significant differences were found locally at the zygomatic buttress (P = 0.019) and the zygomatic arch (P = 0.027) on the fractured side in dipod fractures. This is the first known study that successfully utilized a mechanical simulator to reproduce physiological intrinsic masticatory loads in a fracture fixation study. This new technology opens avenues for future biomechanical investigations on maxillofacial fracture repairs and other surgical treatments.
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Anand M, Panwar S. Role of Navigation in Oral and Maxillofacial Surgery: A Surgeon's Perspectives. Clin Cosmet Investig Dent 2021; 13:127-139. [PMID: 33883948 PMCID: PMC8055371 DOI: 10.2147/ccide.s299249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/06/2021] [Indexed: 12/21/2022] Open
Abstract
Surgeries related to the maxillofacial area deal with an intricate network of anatomical structures. With the complexity of the vital structures, it necessitates a surgical team to respect each anatomical boundary. In the past, there was an exceptionally high number of cases with surgical errors. These errors were not because of flaws in the surgeon’s skills or techniques but owing to lack of resources. Visualisation is one of the key factors that determines the precision of any surgical outcome. Advances in surgical planning have led to the introduction of a “Navigation” system that helps surgeons to see more, know more and ultimately do more for their patients. The usefulness of the navigation system in oral surgeries has been indicated by its surgical applications in craniomaxillofacial trauma, orthognathic surgeries, head and neck pathological resections, complex skull base surgeries and surgery involving temporomandibular joint. A vast majority of research literature has suggested remarkable improvement in surgical outcomes under the guidance of 3d planning and navigation. However, with such an inordinate advancement, financial expenses and a gradual learning curve are always a constraining factor in surgical navigation. This article overviews indication of navigation in craniofacial surgeries with a focus on applied aspect, planning and solution to the future problem.
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Affiliation(s)
- Manish Anand
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
| | - Shreya Panwar
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
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Inferomedially impacted zygomatic fracture reduction by reverse vector using an intraoral approach with Kirschner wire. Arch Plast Surg 2021; 48:69-74. [PMID: 33503747 PMCID: PMC7861973 DOI: 10.5999/aps.2020.02173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/29/2020] [Indexed: 11/08/2022] Open
Abstract
Background In inferomedially rotated zygomatic fractures sticking in the maxillary sinus, it is often difficult to achieve complete reduction only by conventional intraoral reduction. We present a new intraoral reduction technique using a Kirschner wire and its clinical outcome. Methods Among 39 inferomedially impacted zygomatic fractures incompletely reduced by a simple intraoral reduction trial with a bone elevator, a Kirschner wire (1.5 mm) was vertically inserted from the zygomatic body to the lateral orbital rim in 17 inferior-dominant rotation fractures and horizontally inserted to the zygomatic arch in nine medial-dominant and 13 bidirectional rotation fractures. A Kirschner wire was held with a wire holder and lifted in the superolateral or anterolateral direction for reduction. Following reduction of the zygomaticomaxillary fracture, internal fixation was performed. Results Fractures were completely reduced using only an intraoral approach with Kirschner wire reduction in 33 cases and through an additional lower lid or transconjunctival incision in six cases. There were no surgical complications except in one patient with undercorrection. Postoperative 6-month computed tomography scans showed complete bone union and excellent bone alignment. Four patients experienced difficulty with upper lip elevation; however, these problems spontaneously resolved after manual tissue lump massage and intralesional steroid (Triamcinolone) injection. Conclusions We completely reduced infraorbital rim fractures, zygomaticomaxillary buttresses, and zygomaticofrontal suture fractures in 84% of patients through an intraoral approach alone. Intraoral Kirschner wire reduction may be a useful option by which to obtain effective and powerful reduction motion of an inferomedially rotated zygomatic body.
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Pons M, Lutz JC, Chatelain B, Weber E, Barrabé A, Meyer C, Sigaux N, Louvrier A. Impact of intraoperative cone beam computed tomography in the management of zygomatic fractures. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:349-354. [PMID: 33248293 DOI: 10.1016/j.jormas.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
AIM To evaluate the impact of intraoperative cone beam computed tomography (CBCT) assessment for the surgical management of zygomatic bone fracture (ZF). METHODS A prospective study was conducted on patients operated on for unilateral ZF during a two-year period. Repositioning of the fractured zygoma was assessed intraoperatively by measuring the position of malar eminences in three dimensions on CBCT. A difference of more than 2 mm between both sides was considered significant and the reduction was judged inadequate. Surgical procedure was adapted to intraoperative imaging findings. RESULTS The surgical procedures of 47 patients treated for ZF were analyzed. In 15% of the cases (7 patients), the intraoperative CBCT showed an inadequate reduction while the morphological results seemed correct. Those patients benefited from an immediate correction of the reduction. From these 7 patients, reduction was optimized further without the need of osteosynthesis in one case, additional osteosynthesis was performed in 4 cases and 2 patients required both reduction and osteosynthesis revision. CONCLUSION Intraoperative CBCT control helps to achieve anatomic repositioning in case of ZF. It may reduce the risk of under-treatment and possible reoperation, and of over-treatment meaning systematic ORIF in all fractures.
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Affiliation(s)
- Mélanie Pons
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3 Boulevard Fleming, 25030 Besançon Cedex, France; University of Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Interactions/Cell and Gene Engineering, 25000 Besançon, France.
| | - Jean-Christophe Lutz
- Department of Oral and Maxillofacial Surgery, University Hospital of Strasbourg, 1 Avenue Molière, 67098 Strasbourg Cedex, France; Laboratory of Engineering Science, Computer Science and Imaging, CNRS, ICUBE University of Strasbourg, 2 rue Boussingault, 67000 Strasbourg, France; INSERM, "Regenerative Nanomedicine" Laboratory, UMR 1260, Faculty of Medicine, 67085 Strasbourg Cedex, France
| | - Brice Chatelain
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3 Boulevard Fleming, 25030 Besançon Cedex, France
| | - Elise Weber
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3 Boulevard Fleming, 25030 Besançon Cedex, France
| | - Aude Barrabé
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3 Boulevard Fleming, 25030 Besançon Cedex, France
| | - Christophe Meyer
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3 Boulevard Fleming, 25030 Besançon Cedex, France; Nanomedicine Lab, Imagery and Therapeutics, EA 4662, UFR Sciences et Techniques, University of Franche-Comté, Route de Gray, 25030 Besançon Cedex, France
| | - Nicolas Sigaux
- Department of Maxillofacial Surgery and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, France; Claude Bernard Lyon 1 University, France
| | - Aurélien Louvrier
- Department of Oral and Maxillofacial Surgery, University Hospital of Besançon, 3 Boulevard Fleming, 25030 Besançon Cedex, France; University of Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Host-Graft Interactions/Cell and Gene Engineering, 25000 Besançon, France
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Shamanaeva L, Diachkova E, Petruk P, Polyakov K, Cherkesov I, Ivanov S. Titanium Nickelide in Midface Fractures Treatment. J Funct Biomater 2020; 11:jfb11030052. [PMID: 32726970 PMCID: PMC7564408 DOI: 10.3390/jfb11030052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/23/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The question of reconstruction of human tissues and organs with the use of medical materials is still open, because of the accurate requirements for their biological and physical features. The aim of this study was to prove the efficiency of titanium nickelide constructors in treatment of isolated orbital floor fractures or combination with zygomatico-orbital complex fractures. Methods: Patients with a fracture of zygomatico-orbital complex and/or low orbital floor (n = 44) carried out different treatments: in the first group, osteosynthesis and endoprosthesis with titanium nickelide structures; in the second group, titan mini-plates osteosynthesis; in the third group (‘blow-out’), endoprosthesis with a titanium nickelide mesh; and in the fourth group (‘blow-out’), conservative treatment and monitoring (archive data) (p > 0.05). The paraesthesia, diplopia, enophthalmos and exophthalmos degree were measured in points. Results: In one year, the first and second groups had no differences in level of paraesthesia (p > 0.05). The absence of exophthalmos and differences between first and second groups, and between the third and the fourth groups with positive dynamics inside the groups were proved (p < 0.05). In the first and third groups, enophthalmos was absent, and it increased in the second and fourth groups (p < 0.01, p < 0.11). Diplopia in the first and third groups was absent, and it increased in the second and fourth groups (p < 0.05, p < 0.01). Conclusion: The elasticity and biocompatibility of titanium nickelide make the implant insertion and restoration of the lower orbital wall anatomy easier, with good postoperative clinical results.
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Affiliation(s)
- Liudmila Shamanaeva
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
- Correspondence: ; Tel.: +7-(495)-6091400
| | - Ekaterina Diachkova
- Department of Oral Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia;
| | - Pavel Petruk
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
| | - Kirill Polyakov
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
| | - Igor Cherkesov
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
| | - Sergei Ivanov
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (P.P.); (K.P.); (I.C.); (S.I.)
- Department of Maxillofacial and Oral Surgery, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
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Kim SY, Nam SM, Park ES, Kim YB. Evaluation of one-point fixation for zygomaticomaxillary complex fractures using a three-dimensional photogrammetric analysis. J Otolaryngol Head Neck Surg 2019; 48:36. [PMID: 31362786 PMCID: PMC6668153 DOI: 10.1186/s40463-019-0359-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of treatment for zygomaticomaxillary (ZM) complex (ZMC) fractures is to achieve stability and restore aesthetic appearance through three-dimensional reduction and rigid fixation. The purpose of this study was to evaluate the stability and aesthetic appearance outcomes of one-point fixation using a three-dimensional photogrammetric analysis. METHODS From March 2014 to December 2014, 34 patients with ZMC fractures were treated by one-point fixation in the ZM buttress using unsintered hydroxyapatite (u-HA)/poly-L-lactide (PLLA) plates. Differences in soft tissue inter-malar height between the fractured side and unfractured sides were evaluated using photogrammetric analysis with a three-dimensional camera (Morphius®) at the preoperative and 1 week, 1 and 3 months after surgery. The differences in bony inter-malar height between the fractured and unfractured sides were evaluated using computer tomography at the pre-operative and 6 months after surgery. The paired t-test was used to compare differences in malar height. RESULTS Six months after surgery, 34 patients achieved satisfactory bony stability and symmetric malar appearances. Comparisons of differences in soft-tissue inter-malar height revealed statistically significant differences between the pre-operative period and 1 week and 1 month after surgery (p < .01). There was no statistically significant difference between 1 and 3 months after surgery. Comparison of differences in bony inter-malar height revealed a statistically significant difference between before and 6 months after surgery (p < .01). CONCLUSIONS When we conducted a three-dimensional photogrammetric analysis, although it has restricted surgical indications, one-point fixation of the ZM buttress using an u-HA / PLLA plate yielded reliable, satisfactory, and safe clinical results in patients with ZMC fractures. CLINICAL QUESTION / LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Se Young Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea.
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Yong Bae Kim
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
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Abstract
The authors present the case of a 32-year-old patient treated for a left, isolated zygomatic fracture following assault. The injury was reduced without fixation via the Keene approach. The same patient presented to the emergency room 16 months later with a right-sided fracture similar to the previous contralateral injury. This fracture was left untreated. Repeated assaults over a 4-year period provide us with a natural history of both injuries, allowing for comparison between the 2 approaches. The authors found that reduction of the arch without fixation led to an outcome without palpable or visible deformity and no impaired mastication. Additionally, considering etiology of injury, such as alcohol or drug use, treatment may provide an important point of intervention to prevent recurrence.
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Jazayeri HE, Khavanin N, Yu JW, Lopez J, Shamliyan T, Peacock ZS, Dorafshar AH. Fixation Points in the Treatment of Traumatic Zygomaticomaxillary Complex Fractures: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2019; 77:2064-2073. [PMID: 31132344 DOI: 10.1016/j.joms.2019.04.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Controversy remains regarding the optimal degree of anatomic exposure, reduction, and fixation required during open reduction and internal fixation of zygomaticomaxillary complex (ZMC) fractures. We critically examined the reported data to compare the patient outcomes after various degrees of ZMC reduction and internal fixation. MATERIALS AND METHODS A systematic review and meta-analysis were designed to test the null hypothesis of no difference in outcomes between different degrees of fixation of ZMC fractures. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried. The quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS Of 1213 screened studies, 13 met the inclusion criteria. Fracture instability at 3 months was greater with 2-point fixation (61.1%) than with 3-point fixation (10.6%; relative risk, 2.5, 95% confidence interval [CI], 1.4 to 3.3). Less vertical orbital dystopia was seen with 3-point fixation than with 2-point fixation (mean difference, 0.9 mm; 95% CI, 0.6 to 1.3 mm). The incidence of infection and malar asymmetry did not differ between the groups. The quality of evidence was very low to low. CONCLUSIONS The reported data were limited by low quality, retrospective studies. However, the meta-analysis of randomized control trial data suggested a superiority of 3 points of exposure and fixation regarding fracture stability. When 2 points appear to provide stable fixation, the potential benefits of a third point should be weighed against the cost, operative time, and exposure/periosteal stripping on a case-by-case basis.
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Affiliation(s)
- Hossein E Jazayeri
- DMD Candidate, Department of Oral and Maxillofacial Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Nima Khavanin
- Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Jason W Yu
- Fellow, Hansjorg Wyss Department of Plastic and Reconstructive Surgery, New York University, New York, NY
| | - Joseph Lopez
- Resident, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD
| | | | - Zachary S Peacock
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - Amir H Dorafshar
- Professor and Chief, Division of Plastic Surgery, Rush University Medical Center, Chicago, IL.
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Intraoperative Ultrasound Control of Zygomatic Arch Fractures: Does Additional Imaging Improve Reduction Quality? J Oral Maxillofac Surg 2019; 77:769-776. [DOI: 10.1016/j.joms.2018.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023]
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Cinal H, Barin EZ, Çakmak MA, Kara M, Yilmaz K, Tan O. Novel Surgical Technique for Repair of Zygomatic Fractures: Lever Technique. Plast Surg (Oakv) 2019; 27:135-140. [PMID: 31106171 DOI: 10.1177/2292550319828791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Zygoma is a very crucial component for the anteroposterior positioning of the midface and for the maintenance of facial contours. Zygomatic fractures are considered as the second most common type of facial fractures following nasal fractures. We have developed a new reduction technique called "lever," which is based on the application of lifting force as an alternative to the methods in which the pulling force is applied. Patients Over a 12-year period, 90 patients were treated with minimal access approach and 130 patients were treated with open reduction internal fixation (ORIF), using the lever technique. Results In the follow-up period, no complications occurred in any of the patients who underwent minimal access approach. Miniplate removal operation was performed in 3 of the patients. Enophthalmos developed in one patient. Since 4 of the 7 suboptimal reduction patients did not experience any functional or cosmetic problems, no treatment was necessary and the remaining 3 patients underwent fat graft due to the presence of malar depression. Conclusion This minimally invasive surgical procedure we have developed can be successfully used both in the minimal access approach and in ORIF, especially in delayed cases. We recommend this method due to the reasons that it is safe to conduct, easy to learn, fast to apply, simple to perform, and also economical to deploy.
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Affiliation(s)
- Hakan Cinal
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Ensar Zafer Barin
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Mehmet Akif Çakmak
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Murat Kara
- Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Kerem Yilmaz
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Onder Tan
- Department of Plastic Reconstructive and Aesthetic Surgery, Ataturk University Faculty of Medicine, Erzurum, Turkey
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16
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Malaviya P, Choudhary S. Zygomaticomaxillary buttress and its dilemma. J Korean Assoc Oral Maxillofac Surg 2018; 44:151-158. [PMID: 30181981 PMCID: PMC6117466 DOI: 10.5125/jkaoms.2018.44.4.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/25/2017] [Accepted: 06/05/2017] [Indexed: 11/07/2022] Open
Abstract
Zygomatic fractures are the second most common fractures of the facial skeleton, after nasal bone fractures. Due to its uniqueness, the malar bone plays a very important role in maintaining appropriate facial contours. Zygomatic fractures can cause ocular and mandibular functional impairment, along with cosmetic defects. With the help of advanced imaging techniques and various treatment options, the management of zygomatic fractures has become more sophisticated and less invasive. This article discusses zygomatic fractures in detail: their clinical and radiographic features, and the various treatment options available.
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Affiliation(s)
- Pallavi Malaviya
- Department of Oral and Maxillofacial Surgery, NIMS Dental College and Hospital, Jaipur, India
| | - Sandeep Choudhary
- Department of Oral Medicine Diagnosis and Radiology, NIMS Dental College and Hospital, Jaipur, India
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Starch-Jensen T, Linnebjerg LB, Jensen JD. Treatment of Zygomatic Complex Fractures with Surgical or Nonsurgical Intervention: A Retrospective Study. Open Dent J 2018; 12:377-387. [PMID: 30202484 PMCID: PMC6129990 DOI: 10.2174/1874210601812010377] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 11/24/2022] Open
Abstract
Objective: Evaluate the 1-year treatment outcome of zygomatic complex fractures with surgical or nonsurgical intervention. Materials and Methods: One hundred and forty-two consecutive patients with a zygomatic complex fracture were enrolled. Sixty-eight patients underwent surgical intervention and 74 patients nonsurgical intervention. The 1-year examination evaluated cosmetic and functional outcome including malar symmetry, ocular motility, occlusion, mouth opening, neurosensory disturbances, and complications. Results: Forty-six patients allocated to surgical intervention responded to the 1-year follow-up examination. Satisfying facial contour and malar alignment was observed in 45 patients. All patients presented with identical position of the eye globe without enophthalmos and normal ocular movement. A habitual occlusion was seen in all patients with a mean interincisal mouth opening without pain of 49 mm. One patient presented with minor ectropion. Wound infection occurred in five patients. Persistent infraorbital neurosensory disturbance was described by 19 patients. The 1-year radiographic examination showed adequate fracture alignment in all patients with satisfying facial contour. However, dissimilar position of the orbital floor was seen in three patients having orbital reconstruction. None of the patients were re-operated or needed secondary correction of the zygomatic complex or orbital floor. Conclusion: Surgical intervention is an effective treatment modality of depressed zygomatic complex fractures, whereas a nonsurgical approach is often used for nondisplaced fractures. Most zygomatic complex fractures can be treated solely by an intraoral approach and rigid fixation at the zygomaticomaxillary buttress. Further exposure of the zygomaticofrontal junction or inferior orbital rim is necessary for severely displaced fractures, which require additional fixation.
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Affiliation(s)
- Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Janek Dalsgaard Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
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Ji SY, Kim SS, Kim MH, Yang WS. Surgical Methods of Zygomaticomaxillary Complex Fracture. Arch Craniofac Surg 2016; 17:206-210. [PMID: 28913285 PMCID: PMC5556838 DOI: 10.7181/acfs.2016.17.4.206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 12/02/2022] Open
Abstract
Background Zygoma is a major buttress of the midfacial skeleton, which is frequently injured because of its prominent location. Zygoma fractures are classified according to Knight and North based on the direction of anatomic displacement and the pattern created by the fracture. In zygomaticomaxillary complex (ZMC) fracture many incisions (lateral eyebrow, lateral upper blepharoplasty, transconjunctival, subciliary, subtarsal, intraoral, direct percutaneous approach) are useful. We reviewed various approaches for the treatment of ZMC fractures and discussed about incisions and fixation methods. Methods A retrospective review was conducted of patients with ZMC fracture at a single institution from January 2005 to December 2014. Patients with single zygomatic arch fracture were excluded. Results The identified 694 patients who were admitted for zygomatic fractures from which 192 patients with simple arch fractures were excluded. The remaining 502 patients consisted of 439 males and 63 females, and total 532 zygomatic bone was operated. Orbital fracture was the most common associated fracture. According to the Knight and North classification the most frequent fracture was Group IV. Most fractures were fixated at two points (73%). Conclusion We reviewed our cases over 10 years according to fracture type and fixation methods. In conclusion, minimal incision, familiar approach and fixation methods of the surgeon are recommended.
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Affiliation(s)
- So Young Ji
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
| | - Seung Soo Kim
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
| | - Moo Hyun Kim
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
| | - Wan Suk Yang
- Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital, Ulsan, Korea
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Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
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Olenczak JB, Hui-Chou HG, Aguila DJ, Shaeffer CA, Dellon AL, Manson PN. Posttraumatic Midface Pain. Ann Plast Surg 2015; 75:543-7. [DOI: 10.1097/sap.0000000000000335] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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"Roller coaster maneuver via lateral orbital approach" for reduction of isolated zygomatic arch fractures. J Craniofac Surg 2013; 24:2082-4. [PMID: 24220411 DOI: 10.1097/scs.0b013e3182a2430a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Numerous techniques have been reported for the reduction of zygomatic arch fractures. In this article, we aimed to describe a technique we named as "roller coaster maneuver via lateral orbital approach" to closed reduction of the isolated-type zygomatic arch fractures. Surgical outcomes of 14 patients treated with this method were outlined.
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Abstract
An easy and useful method designed for the reduction of delayed and displaced zygomatic arch fractures used by the treatment of a 33-year-old female patient is presented.
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Abstract
The zygomaticomaxillary complex (ZMC) has important aesthetic, structural, and functional roles that need to be preserved and/or restored during treatment of facial fractures. Surgical treatment of ZMC fractures is indicated when there is displacement of the bony fragments, and open reduction and internal fixation is the treatment of choice in cases of comminution or fracture instability. The surgical approaches used for fracture reduction as well as the type, number, and location of the fixation will be determined by the pattern of the fracture and the surgeon's preference. This article discusses the main points of the management of ZMC fractures.
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Toriumi M, Nagasao T, Itamiya T, Shimizu Y, Yasudo H, Sakamoto Y, Ogata H, Kishi K. 3-D analysis of dislocation in zygoma fractures. J Craniomaxillofac Surg 2013; 42:397-402. [PMID: 23891273 DOI: 10.1016/j.jcms.2013.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/02/2013] [Accepted: 06/03/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE When fractured, zygomas rotate and dislocate. The present study quantitatively elucidates the pattern of the rotation. METHODS 50 patients with tri-pod-type zygoma fractures were involved in this study. After defining a 3-dimensional coordinate system--consisting of the M-L axis (the axis directed from the medial to lateral side of the skull), I-S axis (directed from the inferior to superior side), and P-A axis (directed from the posterior to anterior side), the degree with which the fractured zygomas rotated around each of these axes was measured using 3-dimensional graphic software. Thereafter, the tendency of the rotation was compared between the three rotational axes. RESULTS Rotation around the I-S axis was the most frequent with a 96% incidence, followed by a substantial margin by rotation around the M-L axis with a 26% incidence; rotation around the P-A axis was rare, with an incidence of 10%. Furthermore, the degree of P-A axis rotation was minor compared to I-S and M-L axis rotations. CONCLUSION The main factor of zygoma dislocation in zygoma fracture is rotation around the I-S axis. This finding is helpful for effective performance to reposition fractured zygomas.
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Affiliation(s)
- Masahiro Toriumi
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Tomohisa Nagasao
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan.
| | - Tomoki Itamiya
- Design Faculty, Tokyo University of Technology, Tokyo, Japan
| | - Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Hiroki Yasudo
- Department of Pediatrics, Tokyo University, Tokyo, Japan
| | - Yoshiaki Sakamoto
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Hisao Ogata
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
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Raschke GF, Rieger UM, Bader RD, Schaefer O, Guentsch A, Hagemeister C, Schultze-Mosgau S. The zygomaticomaxillary complex fracture – An anthropometric appraisal of surgical outcomes. J Craniomaxillofac Surg 2013; 41:331-7. [DOI: 10.1016/j.jcms.2012.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 10/16/2012] [Accepted: 10/18/2012] [Indexed: 11/27/2022] Open
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Raschke GF, Rieger UM, Bader RD, Schaefer O, Guentsch A, Schultze-Mosgau S. Transconjunctival versus subciliary approach for orbital fracture repair—an anthropometric evaluation of 221 cases. Clin Oral Investig 2012; 17:933-42. [DOI: 10.1007/s00784-012-0776-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
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